Legacy Society Estate Designation Form

The National Academy of Kinesiology Legacy Society honors the five original members of the Academy:

Clark W. Hetherington, champion of developmental play and educational athletics;
R. Tait McKenzie, physician, scholar, and sculptor, who created the Academy medallion, the Gulick Medal, and many pieces of sport art;
William Burdick, city recreation specialist and administrator;
Thomas A. Storey, physician, health educator, and first New York State Supervisor of physical education; and
Jay B. Nash, philosopher of recreation and advocate of the development of the “whole person” through creative leisure.

These five individuals, whose names distinguish the history of American physical education, met in New York City in 1926 to initiate action which led to the founding of the present National Academy of Kinesiology.

Membership is open to those who have designated the National Academy of Kinesiology in their estate plans. Any size commitment qualifies an individual for membership. In addition to helping ensure the long-term financial viability of the Academy, members have the opportunity to motivate others to designate the Academy in an estate plan or support the Academy during their lifetimes.

To qualify as a member of the National Academy of Kinesiology Legacy Society, please provide the following information:

Your Name*

First NameLast Name

Your Email*

example@example.com

1. Document type:*

2. When does this occur?*

My deathDeath of spouse or partnerDeath both spouses or partners

3. Please describe the nature of the gift:*

Percentage of estateSpecific dollar amountSpecific item(s)

Percentage of Estate %

Specific Dollar Amount $

Specific item(s):

If your gift is to be restricted (i.e., designated for a specific purpose) in any way, briefly indicate the proposed nature of the restriction.

(Optional) I (we) would like to have my (our) name(s) listed as a member of the National Academy of Kinesiology Legacy Society, as follows:

The National Academy of Kinesiology will accept gifts to support the mission and goals of the Academy. All gifts must be consistent with the ethical values and principles of the Academy.

Date

For gift crediting purposes, I/we understand that we should notify the National Academy of Kinesiology if changes are made to my (our) will/insurance policy/trust/retirement plan designation or other instrument that will affect this provision. This confirmation, in and of itself, is not intended to be binding on my/our estate.